From the Guidelines
The recommended treatment for endophthalmitis involves immediate intravitreal antifungal agents, typically voriconazole or amphotericin B, with or without vitrectomy, in addition to systemic antifungal agents. The choice of treatment depends on the extent of the infection, the involvement of the macula, and the antifungal susceptibilities of the infecting species 1.
Key Considerations
- Sight-threatening lesions near the macula or invasion into the vitreous usually necessitate intravitreal injection of antifungal agents, usually AmB deoxycholate or voriconazole, with or without vitrectomy, in addition to systemic antifungal agents 1.
- The antifungal susceptibilities of the infecting species are important, with species that are susceptible to fluconazole or voriconazole being more easily treated because these agents achieve adequate concentrations in the posterior segment of the eye, including the vitreous 1.
- Treatment must be systemic to treat candidemia and other organ involvement, if present, in addition to the ocular infection 1.
Treatment Approach
- Intravitreal injection of either AmB deoxycholate or voriconazole to quickly achieve high antifungal activity in the posterior chamber 1.
- Systemic antifungal agents, such as fluconazole or voriconazole, to treat candidemia and other organ involvement, if present 1.
- Vitrectomy may be necessary, particularly for severe cases with vision worse than light perception, to remove the vitreous and achieve high antifungal activity in the posterior chamber 1.
Monitoring and Follow-up
- Daily follow-up initially to monitor response to treatment 1.
- Regular monitoring of visual acuity and intraocular pressure to adjust treatment as needed 1.
From the Research
Treatment Options for Endophthalmitis
- The recommended treatment for endophthalmitis varies depending on the cause and severity of the infection.
- According to 2, early intravitreal treatment with antibiotics, administered within 24 hours of diagnosis, may provide a relatively favorable visual prognosis for endogenous bacterial endophthalmitis.
- For filamentous fungal endophthalmitis, a combination of intravitreal amphotericin B and voriconazole, along with pars plana vitrectomy, may be an effective treatment strategy 3.
- Immediate vitrectomy with intravitreal injection of antibiotics can be an effective approach for the treatment of acute endophthalmitis following intravitreal injections, with most eyes recovering vision within 8 months 4.
- Intravitreal corticosteroids may be used as an adjuvant to antibiotics in the management of infectious endophthalmitis to reduce inflammation, although their use is still controversial 5.
- In cases of recalcitrant postoperative endophthalmitis, intravitreal daptomycin may be considered as a treatment alternative, especially in cases of vancomycin resistance 6.
Key Considerations
- Prompt treatment is crucial in preventing vision loss and improving outcomes in endophthalmitis.
- The choice of treatment depends on the underlying cause of the infection, with bacterial and fungal infections requiring different approaches.
- Combination therapy, including intravitreal antibiotics, corticosteroids, and vitrectomy, may be necessary to achieve optimal results.
- Close monitoring and follow-up are essential to ensure the infection is fully resolved and to address any potential complications.